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Thursday, July 30, 2009

Yesterday was our third quarterly Kwejuna Project food distribution of the year, and though we prepared for a substantial spike in the number of HIV-infected women who would appear, we were still stretched to the limit to serve the 306 who registered. Scott gave a small sermon with five mandazis (local breads) and two real skinny little lake fish from the market as visual aids, and we sensed the same need that Jesus' disciples did for some order in the chaos and miraculous provision from God to pour out His care on so many people. And God did, as He has each time in the past. The Kwejuna Project is a huge team effort, drawing in pastors, elders, lab techs, midwives, patients, peer counselors, community people, and missionaries. And this time, parents! The Elwoods (Nathan's parents) and the Lutjens (Heidi's parents) arrived Weds night, and by Thursday morning they were fully involved in the effort. In the tradition we started years ago with Bethany's dad, we simply asked them to pray in small groups for the women who wanted spiritual encouragement. Several times during the day, as I had to break the tragic news to a mom that her baby's HIV test was positive, I was able to then refer the weeping woman to the sympathetic arms of her peers and these caring prayer warriors who would lay hands on her and pray for God's comfort. In spite of those moments of sadness, the general atmosphere of the day is always that of a celebration. Celebrating continuing life. Celebrating community, that the women find themselves in a large company of people who face the same problems. Celebrating improbable connection across continents as we give calories for survival that have been donated by American friends. And this is a safe place for these women to celebrate with each other the triumph of a baby's negative test (dozens!), the hope of a healthy child to care for them as their own disease progresses in the future, the assurance of continuity in their family in spite of their own impending mortality.

Wednesday, July 29, 2009

Single women are the strong backbone of our team. Yesterday four of them sat on a bench together at chapel (the 5th strong woman, Heidi, was taking responsibility to send off our interns and drive two families back from Kampala). On the end of the bench was Pat who had come down to the Pediatric Ward the day before to see if she could be helpful, and within a few minutes we realized one of our severely malnourished patients was dying, but the little boy's father had left to get help, so that only an 8-year old scared and crying sister remained. So Pat spent almost the whole day holding Sunday, as I checked on him intermittently and the nurses did their best to push blood and fluids and medicines to rescue him. She gave the gift of encircling arms, so that this little boy did not suffer alone, so that he spent his last hours on earth loved. He died that afternoon. Next to Pat sat Kim, whose visit back to our team has been a breath of fresh air, a listening ear, a praying heart, a solid wisdom that many of us have drunk in. Then Sarah, who sat holding hands with A., a CSB support staff who after almost 8 years of being drawn into community as a student and then staff member at CSB, made a profession of faith in March during a Bible study with Sarah. Loving someone from a different world religion into the Kingdom of God, giving them the courage to break with family and follow Jesus, is an amazing thing. And next to Sarah, Ashley, anchoring Julia to the end of the bench, a faithful teacher and role model, coach and friend, who gives Julia and all of us staying power in a difficult place. Jesus chose to reveal His resurrection first to the single women. On their testimony, love, and work, the Kingdom is built.

There is a heavy physical cloud over Bundibugyo this morning, the kind that brings thick humid air and dim morning light, the kind that slows movement and paints the world in discouraging colors. We could use some cloud-lifting prayers today. Over 200 families will begin arriving for Kwejuna Project in the next hour, and it is an all-day all-out effort to interact with each, ensure that they are enrolled in preventive care, to weigh and measure and dispense, and to pray for them in small groups. As the school term winds down into it's final two weeks, so does our summer and its plethora of extra projects and ministries, all good but also draining. Caleb keeps reminding us that he will leave home, essentially, in less than two weeks, and Luke keeps reminding us that we are in some ways less available to him in person than by phone at RVA. On Tuesday I found 49 patients admitted to our 23-bed ward, and yesterday I enrolled our 31rst severe acute malnutrition admission for the month (previous average 13/month). There are heart-aches and griefs among the people we care about; there is change ahead for our team as we evaluate Christ School and its improvement. The sheer coordination of meals and movements feels complicated; no one is getting the attention they deserve. Yesterday Scott spent most of his morning caring for a neighbor who fell out of a tree as he was trying to cut branches from it inour yard, who broke his ankle and possibly has vertebral fractures, serious injuries. And to top it all off, there is a dead something somewhere in our walls, attic, or under an un-movable sink cabinet, so our bathroom is permeated with a putrid smell which we've failed to locate the source of.

God's presence is pictured as a cloud. So perhaps our prayer should not be for the cloud to lift, so much as for our vision to clarify, to expand, to realize that God is God and works in His own ways that we can not control or predict. So please pray for us today: for a lifting of the oppressive sense of too-much . . or for a deep faith that we are immersed in the cloud of the substance of God Himself.

It was a privilege to have three extra WHM kids with us over the
weekend: Tim who grew up in Granada where his parents are the Spain
team leaders; Libby who spent her early years here in Bundi until her
dad became the Director of Ministries for WHM in Philadelphia; and
Acacia who just left last year as her family established the new team
in Sudan. I marveled at how our boys connected to Tim, their boarding
school/parents as team leaders/TCK-ness providing a deep bond. This
afternoon Libby and Acacia walked in and eagerly accepted rice and
sombe (cassava leaf) I was re-heating, the familiar foods of their
childhood. A few minutes later I heard Melen saying "my ma ma ma ma
ma ma", a long exclamatory phrase, and wondered if she was OK, but it
was just that she had walked up to the house and seen LUKE for the
first time in months, and could not believe how TALL he was. Whoever
drops by rejoices with us in the growing and maturing of kids they've
known since they were infants, and it is fun to experience that
(something we would have a harder time finding in the US!). I'm so
thankful to welcome all these kids "home".

Monday, July 27, 2009

Back from the weekend, and thankful for prayers. Moving 29 people in 5 vehicles from two countries and on different schedules, all to converge for 48-hours of rest and community, is no small thing. We are grateful for the relaxed atmosphere of the Kingfisher, the stunning vista from the escarpment as rays of the setting sun broke through misty clouds. We are grateful for laughter around the small pool, or during games and meals. We are grateful for a handful of good heart-to-heart talks with departing interns and visiting friends, glimpses of bigger things God is doing in peoples' lives. We are grateful for a majestic view of a satiated lion, who sauntered into the bushes when we made too much noise; for up-close elephants munching trees; for dozens of baby wart-hogs (our favorite animal, which is so ugly it is cute in miniature); for herds of fierce-looking buffalo. We are grateful for an evening of prayer, launching all our visitors (2 Uganda interns, 2 Sudan interns, 1 intern from last year who came back to visit, our short-term doc, and 1 former team kid . . ) back to America.

But the rest ended as we descended back into Bundibugyo--the car-sickness from bouncing and jolting squished in the back seat of the truck combined with the general spiritual oppression which hangs over Bundibugyo like a cloud. Within ten minutes of pulling up into our yard we were confronted with a sick cow, a malfunctioning fridge, and a police problem with one of the nutrition motorcycles. Scott took on the first two, the kids unloaded the truck, and I accompanied our anxious extension worker to the police station where amidst wafting alcohol we extracted the motorcycle and a pledge that they would pay for the minor damage incurred when the impounding officers illegally took it out for a ride and had an accident. By 5 our man was back on his way to deliver our locally-made nutrition-supplementing food to outlying health centers, and we were back to unpacking and sweeping and sorting out our own dinner issues.

Scott, and Luke, took some great photos of the weekend - (click on the FlickR photos on the sidebar to see more). And pray for the next two weeks, which will be a full push sprint right up to the finish.

Thursday, July 23, 2009

Last night we began the goodbye process, with pizza and presents and . . . a sort of a square dance to "She'll be coming 'round the mountains when she comes . . . " with lines dedicated to some of the funnier aspects of Tim and Doug's summer. Jack could not believe it is already time for them to leave, and our kids always find it sad to see more people departing from their lives. We have appreciated their patience with us, enthusiasm, and flexibility. They saved at least one life, finding a severely malnourished child with TB on one of their outreaches and bringing him in for treatment. They also were present at too many deaths, children who came in their last moments and did not survive. They preached, researched, gave out food and medicine, played games with small children, killed snakes and spiders, prayed, and processed what it means to live with God in an area of poverty and hardship, what the Kingdom might look like, and how to live in community. They struggled with cross-cultural relationship and being stared at day in and day out. They learned to eat substances not found in their normal lives (like cassava leaves or big bizarre lumpy tropical jack-fruits). Mostly they just laid down their lives to pull alongside of us for almost two months.

In a few hours we will all head out to a weekend at the Kingfisher Kichwamba, on the edge of the Queen Elizabeth National Park. We will also be saying goodbye this weekend to the Pierce's friend Brian and to a doctor nearing the end of her residency, Naomi, both of whom joined us for the last ten days. We will join the Sudan interns with Acacia Masso, our former team mate Kim, and our former team kid Libby. Praying that somehow in the mix of getting 30 people on game drives and fed and accommodated and transported, there will be moments of real connection with God and each other, glimpses of His glory in creation, and a sense of rest.

Wednesday, July 22, 2009

God has been so good to us in the process of inviting two educational consultants to Christ School. The idea for this process came from our field director during our regional team leader retreat in April, and after his HMA plans caught up with him the responsibility for the actual logistics fell to me. Or rather, to the Spirit . . .who guided us via a scattering of emails to universities and church headquarters to the names of two men. One is a professor of education at Uganda Christian University (and was a key author of the latest legislation regulating education in this country), and the other heads the Church of Uganda's Education office (which makes him responsible for five thousand primary and five hundred secondary schools). Both have many many years of experience as teachers, as headmasters, as teachers of teachers. It would be hard to imagine two more competent and connected consultants than the two we got! Both are slightly older than us, established men with families and careers. Yet both received Tim and I graciously back on the very first day of their internship in June when he bravely joined me on buses and bodas to search out the offices and make the arrangements. Now almost two months later, the visits have occurred. Each offered a slightly different perspective and style, and each will continue to give us unique insights and connections as we receive their written reports and lean on their wisdom. But perhaps the unexpected thing: it was enjoyable. We can get so bogged down in the problems in front of our faces, in the discouragement of seeing the gap between reality and the ideal . . that it helps to have someone from outside, someone who knows what they are talking about, come in and ask questions and take notes and tour classes and interview parents and students and community leaders, and then conclude that CSB is the best school in the area, that the facilities place it in the top 15% of schools in Uganda, that the community feels blessed by the orphan sponsorship program, that the spiritual emphasis is palpable.

There is work to be done. A lot of it. We need written policies in many areas, a standardized plan for the curriculum, better books. We need to work out regulations for our boards, roles for the mission and the administration. We need to reduce dependence on outside donations by increasing our political savvy when it comes to in-country grants, which could improve sustainability. We need to pay teachers higher salaries, which might enable us to increase the professional level of our staff. This will take time, years, though we can make a good start within the next year, the process of strengthening community ownership and internal accountability, will not happen overnight. The fruition of stability will likely occur beyond the lifespan of any of the current missionaries. Pray that new families ready to dedicate themselves to this vision, would begin to emerge. Pray that God would lead us to excellent and godly Ugandan teachers and administrators, as well. If there are people like these two men out there, then anything is possible!

And that is probably the greatest thing the consultants offered: perspective. This school has great potential. The decade of work so far has borne fruit. The problems we see are not unique, and those who have lived and worked in Uganda far longer than we have give us hope that it is worth the effort. Pray for us to take the advice to heart, to consider bold change, to honor our commitments to the families of students, to strive for God's glory in this place. As the teachers like to write on the bottom of exams . . the struggle continues.

Tuesday, July 21, 2009

Burials occur in Bundibugyo on a daily basis. And attendance at burials is an extremely important part of the culture. I don't feel that we fully understand why people attend burials. Surely, there is some part in which people provide emotional support to one another in their grief, but I frequently see people attend who had little relationship with the deceased (or their family). There may be some peace-keeping aspect with the recently departed spirit as well as a peace-keeping with the family remaining behind. People being people though, there is also an "attending to be seen" aspect. Important people attract larger crowds, some who are curious and some who just want to be associated with the power or prestige to give the impression that they had some relationship with the important person or their family.

Today, two local people were buried. One was the wife of a local "big man", a man who holds a powerful government position (presidentially-appointed) in another district. As a woman, she was important only by her association with the power and prestige of her husband, but many, many people came from far and wide. People came to see and be seen.

The other burial was attended by a scant few. The one buried was an elderly codger, the sort who you might imagine in line for the downtown homeless soup kitchen, who came to our church and was considered by most to be a bit of a nuisance and disturbance. He straggled in and wandered out pretty much at random in his tattered, odoriferous rags always carrying a long walking stick. He often interrupted the service with his raucous speech and loved to move around shaking hands with as many as possible. He also would often fall asleep on the back of the church during the sermon (- when one of our single women fell asleep in church recently some of the little children started calling her by the nickname used for this old vagrant). It made me happy to see this old beggar in church because I believe Jesus would have welcomed him to his feast table. I can't think of a better picture of "the least of these my brethren."

He died alone. Neglected by his family. But my heart was encouraged this afternoon to hear that a small delegation of leaders from our small church chose not to attend the prestigious burial of the politician's wife, but of this little old man, a veritable nobody. They buried him and preached a message of the gospel, that God loves us in our weakness, in our sorry begging state.

I attended neither burial, choosing rather to spend the day pursuing an x-ray of Luke's ankle. However, in a private moment I shed tears for that old man who came to church with nothing and left this world with nothing.

I think I might hear the soft echo of his coarse voice in praise of the everlasting King.

The children on the pediatric ward are like the proverbial canaries in the mine shaft, small and vulnerable, the first to show signs of impending disaster. Over the last few weeks I've been noticing stories in our national paper, stories about famine. Irregular weather patterns have diminished rain across northern and eastern swathes of the country, and thirsty land is failing to yield enough food. It occurred to me today that our pediatric ward serves as an early warning of hunger. in 2008 our average admissions for severe acute malnutrition were 13/month. In early 2009, we were continuing to average about 10. In July so far, we have admitted 26, with 23 still on the ward, and the month is far from over. The summer months are the hungriest time of the year, pre-harvest. And our ward continues to reach out further and further as desperate people come hoping for help. Training community health volunteers means we now have active case-finding in many villages; we are not just waiting for the children to come to us. All of that could be boosting our admission rates, but I think there is also a larger trend towards hunger in the community. Rising global food prices, shortages of rains, over-commitment of land to cocoa rather than food, population pressure all begin to squeeze the neediest families. So the children who have chronic illness, whose mothers have died, who live on the margins, begin to show the signs of hunger first.

When I counted the admissions today, at least it made sense, no wonder the workload feels so intense, the sorrow there so palpable. Pray for rescue for these little canaries, and bigger rescue for the continent where AIDS and drought and entrenched poverty and swelling families all push the weakest right over the edge.

We do not know the thousands of times a day God allows His angels to intervene, to protect us, to keep a kid out of the path of a careless driver, to prevent the transmission of a deadly disease. But we could use a few angels assigned particularly to ankles on our team. Sarah sprained hers on Sunday, after Jack, Scott, and Doug in the weeks before, all pretty mild. Ashley had a severe ligament tear a few months ago. And the latest to fall was Luke, playing with his old friends at Christ School Monday on the first day of his break. For months he has been talking about how he looks forward to coming back here to play every day, to run and kick the ball, to get in shape for the Fall soccer season at RVA. So when he went down in a slide tackle on the FIRST DAY BACK, and nearly passed out from the pain as his ankle quickly doubled in size . . it was a huge loss. Today the xray does not show a fracture, but it could still be weeks to a month, or more, before he's playing again, and will potentially impact his ability to play at RVA. For those who remember how hard he worked to get on the team last year, and then missed almost the whole season with a knee injury, you will appreciate just how sad this is for him, and by extension for all of us. The spate of injuries relates to hard play, rough fields, and gripping cleats. And to the general background of trouble in this world.

About an hour before his injury, Pat and I had been talking about parental faith, about Abraham and Isaac, and praying specifically that we could believe in God's goodness even when our kids are not well. I find the timing pretty amazing, that God put this on Pat's heart and mine, that we actually were prepared by prayer to accept this from His hands. Jack piped up at dinner that we can't know God's plan, and maybe the immobility of this sprain is saving Luke's life in some other way (as in the aforementioned road risks). Out of the mouth of babes.

So we plod on in faith, hoping for a miraculously fast healing of the ligaments, praying that Luke would not be discouraged, that he would find other ways to relate to his friends, that he would rebound by September. And we ask for continued prayers for the thriving of all our kids, who often seem to be stretched on the altar as vulnerable as Isaac, waiting for the ram in the thicket.

Sunday, July 19, 2009

On Sundays, in the late afternoon, we have grown into the habit of "family soccer", a relaxed time of exercise and fun together. Our kids play almost every other day with their skilled friends, but on Sundays they enjoy being the stars of the show at home. This year most of the single people on the team have joined us at one point or another . . and this summer even the interns, neither of whom had any particular prior interest, fell into the routine. It was Doug's idea I think to create the last-Sunday challenge, Myhres vs. Singles. Since both Nathan and Ashley were all-American athlete soccer players in college, we did not agree lightly, but banked on Luke's return and Caleb's growing skill, combined with Jack and Julia's solid playing, to at least give us a chance (and you would never guess Scott is twice the age of everyone on the other team to see him go at it .. . ). The final score was 10 to 10, in about an hour and a half of very evenly traded goals, though it could have been way less even I'm sure if Nathan had not mercifully restrained himself against most of us and only unleashed his real self on Luke. Or as we prefer to say, the score was "fun to fun". We did come out of the game with one more sprained ankle (Sarah this time), sadly. But otherwise it was great fun.

But we have this treasure in earthen vessels, that the excellence of the power may be of God and not of us. We are hard pressed on every side, yet not crushed . . .

Luke took pottery as a term-length elective, and seems to have found one of his callings in this very African art form. Pictured above are the projects he packed home to show us. He loves the hand-in-clay creativity of working with the wheel, and the challenge of making something of symmetry and beauty that will stand the firing. His teacher is a master, and drew spiritual lessons too, that God knows what we must endure and models our clay sides just thick enough to withstand the particular trials of our lives.

Last night the students at CSB were brought out under the stars on the football pitch for an old-fashioned revival meeting, thanks to the visit of the Pierces' friend Pastor Brian. There was singing and dancing, prayer and preaching, and a call for students to make decisions for Jesus. I was sitting on a mat at the rear behind some pretty rowdy boys, and the few lanterns and moonless night did not allow a clear picture of how many responded, but I'd say it was substantial, at least a couple of dozen kids walked forward, maybe more. Exciting for me, one was a student we love dearly and have sponsored, a good friend of our kids. I was reminded of our own son's standing for Jesus in a similar "spiritual emphasis week" event at his school . . . and thankful that the students at CSB got a little taste of the same. More and more the two schools represent for me not so much two cultures as two points on a timeline, and what is good for one group of kids is generally good for another. We've been told we're a bit like soft grandparent-types when it comes to tolerance of student behaviour . . .and that is probably true, because even though last night a lot of the raucous dancing during the singing was closer to the cultural all-night youth-gathering dances of the Babwisi than it was to a worship service, I was glad those kids got to be outside, moving, shouting, letting off steam and enjoying themselves. Then to add to that, they got to hear the gospel again, to be invited to respond, to have the chaplain following up by taking down names and classes to be sure these kids are discipled, all that was great and an answer to prayers.

Keep CSB in prayer, always, but particularly right now. The second consultant arrives tomorrow, and the first contributed a lot of perspective on how we could be more connected politically and support our school through local as well as international funds and personnel. Meanwhile we have not only Brian here this weekend, but a former teacher Eric who was very pastoral in his time at CSB and prayed with and influenced many students. He's in seminary now in the US and will be for the next few years, but visiting this week because he's about to marry a young woman he met when she was a missionary teacher at our school, Joy. We enjoyed welcoming them "home" last night before the revival meeting, along with a handful of their favorite teachers (and ours) so that we could celebrate the community of our work together and God's grace in their lives. We continue to pray for the miraculous provision of a Ugandan headmaster who would work with the Pierces, enabling them to step back and focus more on the big picture issues of funding, development, spiritual growth, staff professional growth. And we pray for more missionaries to come in behind them and us as they anticipate finishing their term shortly after we also go on HMA, in just over a year from now. It feels like a lot to ask God, but a verse I read this week from Psalm 147 says that God does not delight in the strength of the horse or the legs of a man (Old Testament equivalents of power, funds, education, competence, plans, resources . . ) but rather the Lord takes pleasure in those who hope in His mercy.

So here we stand, hoping in His mercy, glimpsing it last night in the raised hands and voices of the students, and longing to see real change in their lives and our own.

God destroyed nations for this practice, and yet it continues. In the West it looks different perhaps, as we sacrifice what is best for our kids in order to further careers, or for convenience. In Uganda it is less subtle, as children are kidnapped and taken to ritual specialists who have convinced their clients that a particular body part offered to spirits will ensure economic success. Link on this blog for a story of a courageous woman who walked away from a life of witchcraft when she was just a child, and was enfolded into the family of fellow-missionary-doctors and friends Robbie and Ian Clark. She just put together a marathon media event to highlight the evil of child sacrifice and celebrate the redemption God brought in her life.http://rosenanyongac.blogspot.com/

Friday, July 17, 2009

Today was also a milestone for Caleb, his last day of classes at
Christ School Bundibugyo. For the last four years he has stuck it
out, taking Chemistry, Biology, Physics, Math, Additional Math, and
Computer Studies. Today the Senior Four students had their last
regular class day, from here on out until the end of the term in
August they will be in study time and then "mock" exams, preparing for
the all-important national exams in October. Since Caleb will not sit
for those, and instead enter RVA a year earlier than Luke did (in 10th
grade at the end of August), it did not make sense for him to take the
practice tests. We are proud of Caleb for learning to be the sole
American in his class, the sole non-boarding student, the sole part-
timer (he has continued to take his humanities classes with our
Rwenzori Mission School teachers), several years younger than anyone
else in his class. He has shown resilience and courage, as well, and
helped bring diversity and challenge to his class mates (his teachers
often assign him things to look up on the internet, and his class
mates love to use his books or compare notes with him on problems).
The end of an era for him, and yet the closing of this chapter heralds
the opening of a new one. He's ready.

Luke is home! That long boy barely folds into a MAF plane anymore.
He flew from Nairobi to Entebbe where the MAF pilot Laura met him, and
then in the Cessna from Entebbe to Bundibugyo, even taking control of
flying the plane much of the way under Laura's supervision. This is
one of the great perks of being a missionary kid. I got teary just
seeing him jump out. He's unpacking some pretty amazing pottery from
his elective this year, he has real artistic talent . . . and a great
GPA too. Today is an ebenezer, a milestone . . hither by grace. A
year ago the idea of sending our child to boarding school was a
painful unknown. Now, looking back, we see God's merciful provision
in Luke's thriving friendships, academic maturity, and spiritual
resilience. We miss the every-day life together, but we also see the
refined gold that comes through trial. And interestingly, I believe
that having a child at boarding school makes us more normal here in
Uganda. It is a point of shared life experience and conversational
contact with most Ugandan parents we know, which I would never have
realized before. So a thanks today, to God for opening the place for
Luke, to RVA for taking such good care of him, to his dorm parents the
Gallaghers and his in-country guardians the Newtons, and to two voices
in our life who kept telling us to keep this door open and to consider
letting him go: Dan Herron and Paul Leary. You were right.

Wednesday, July 15, 2009

My Aunt Von died today, after more than 90 years of life. Since my dad was the youngest of 15, and my mom of 5, I have grown up all my life with a bevy of older aunts and uncles. But Aunt Von was special, cut from her own cloth. She was still wearing high heels and lipstick and driving her cadillac into her last decade . . . but she was also a country girl from West Virginia that could stir up a copper kettle of apple butter, or mow her own lawn when most of her contemporaries were using walkers. She ran a roadside snack bar for much of her life, under the sign "EATS", right next to my uncle's gas station, where we would help her boil up vats of vinegary sharp cucumbers to make her own pickles to put on the burgers . . . and she also had an incredible wardrobe of stylish hats and handbags (which we were allowed to dress up in, or later to borrow). She worked, hard. And spoke her mind, whether anyone agreed with her or not. She worried, especially about us. She wondered why we had to go to Africa when there were plenty of sick people in West Virginia. And even though I'm a pediatrician and know nothing about geriatrics . . . she wanted me to review anything her doctors prescribed, and would only take her pills if Scott or I told her she should. She was there at our graduations, our weddings, any time we came home. She sent me the beautiful red dress I've worn on Christmas for about five years running, because she thought I needed something pretty. I did. For most of my life, my Aunt Von filled the role that most people have for grandmothers ( I loved the only grandma I knew, but she was very old, lived further away, and I was one of a hundred progeny in her life). I'm sure she exasperated her siblings with her stubbornness, but not me, because all the force of her will was always in my favor.

My Aunt Von was a living example of grace. For no good reason, way before we were old enough to distinguish from the rest of the cousin crowd, she decided that my sister and I were special, that if I said so it must be right, that I would be the smartest doctor, or looked like a movie star. Once she decided so, she stuck with her opinion, fiercely loyal. And her love extended to Scott and our kids. There is no one besides my parents that could have been more determinedly devoted.

Tears have flowed freely today, and frequently. Aided no doubt by tangible sadness right under my hands, including a baby who died while we tried to save her life, the 5th of her mother's five babies to do so, in spite of months of nutritional therapy she had disappeared into Congo and only resurfaced cold and withered with gasping breaths and convulsions. I could not stop the shattering of this mother's life yet again, and I wished I was back closer to my family in this time of grief instead of in this hospital full of neediness and disaster. It was a long day, and my team mates bravely gave me hugs, listening ears, and space when I needed it, to make it through.

So tonight I reflect on this woman who gave me grace, my whole life. Barely 5 feet tall (in heels), not prone to speak of religion, still she was a picture of God for me, of unconditional and undeserved love.

Tuesday, July 14, 2009

We welcomed two more visitors today, Dr. Naomi who is spending two weeks with us in the midst of her family practice residency to further pursue God's call to missions, and Brian a friend of the Pierces who came for a similar period of time to encourage them. The MAF flight that swooped out of the clouds to deposit them into our lives also took Pamela out, after a brief but full visit of reconnecting with life and friendship here. So more hugs, introductions, hellos and goodbyes. Pat and I took Dr. Naomi almost directly to a burial, perhaps an inauspicious first hour in Bundibugyo, but somehow appropriate. The oldest daughter of a prominent community leader died of AIDS yesterday, and pretty much everyone we know had turned out to show solidarity and sympathy. As we walked away from the grave with the crowd, I got a phone call: Please come to the health center RIGHT NOW, we have more visitors.

So Scott and I biked down, to find most of the staff milling about, and within a few minutes an entourage of four fancy SUV's pulled in. Dr. Sam Zaramba, the Director General of Health Services for the country of Uganda, had arrived. This senior official serves at the very top of the government health structure, second only to the Minister of Health himself. He was accompanied by Dr. Amone who has become a friend and supporter of our work since our ebola days together, and by our chief of health in the district Dr. Sikyewunda, and a half dozen other officials from the Ministry in Kampala and from the district. They toured the health center, which is seems has a national reputation as one of the most functional health centers in the country (!). At one point Scott had the opportunity to give his focused and articulate advocacy speech: with facts and figures he explained how the patient care at Nyahuka Health Center is equivalent in volume and service level to that offered at the hospital, with 1/20th of the budget. After the tour we all sat down with the staff, and these officials thanked "the Dr. Scotts (that's me too!) and World Harvest Mission" for the support in buildings, personnel, training, drugs, and equipment . . and mentioned specifically that Scott attended to Dr. Sessanga when he had ebola and when NO ONE else would go in his house, which spoke volumes and has not been forgotten even now . . .it was a little embarrassing but OK we admit kind of nice. However the most hopeful thing: Dr. Zaramba was the one who came up with the whole health system structure for Uganda, and he declared that highly performing health centers should have different budgets than barely functional ones. As his underlings took notes he promised to address the budget, and increase it!

I was asked to open the meting in prayer, and then as they got ready to go they asked me to pray for "traveling mercies" once again. I really loved the opportunity to pray by name, loudly, for the health leaders of this country. Amen.

Mugume went home today: the child who arrived on the 22nd of May, as severely malnourished as it is possible to be without being dead. He had this incongruous body shape with grossly swollen limbs below the knees and elbows, but skeletal ribs and skull, he was listless, cool, moaning, hardly responsive, with a pregnant mother and distracted father who had traveled from Congo on foot and seemed confused about his name and age let alone anything concrete about his history. Initial feeding only made his Kwashiorkor swelling worse, and I felt there was very little chance he would survive, expecting every morning to find he had passed away during the night. But somehow, he held on, through weeks of milk and antibiotics and searching for the cause of his illness. At the end of the first month he had made no progress other than survival, and we decided he might have TB. We started the TB drugs the day before my birthday in late June, and the response was immediate and dramatic. For the last three weeks he has made steady, daily improvement, his face rounding out, reconnecting with the world, standing on his spindly weak legs, reaching for my pen, even beginning to talk and smile. I love seeing this time-lapse resurrection, this flowering of life in a body that was nearly dead. And I love seeing hope emerge in a mother. After nearly two months, it was time to send him home.

But directly across the aisle, Masika died. This little girl was severely brain damaged, developmentally delayed, abandoned to her grandmother, and found during her admission to have sickle cell disease as well. No child should die of hunger, and though her overall life prognosis was poor we struggled to feed her and bring some measure of health into her life. But over the last 24 hours she deteriorated, and in spite of a blood transfusion and IV antibiotics, become worse and worse. By this morning her long-gone mother had returned only to wail and mourn as she breathed her last. That was brutal, the screaming despair of this mother went on and on, perhaps compounded by her guilt in having been absent for most of the last year of her daughter's life as she had moved on to another marriage.

There is no simple way to make sense of these two stories, two stories repeated over and over bed after bed throughout the ward. For every few kids that are rescued, that respond, that revive . . .. there is another that dies. In fact as soon as Masika's bed was cleaned up, another severely handicapped child with a similar story (mom gone, grandmother the caretaker, spastic cerebral palsy with a tiny head and terrified eyes and peeling skin . . .) moved into her place. Why does Mugume get another life, But Masika does not?

I can't answer that, and it is not my job. I can only hope that through the lens of eternity, God's goodness will triumph over the sorrow in both of their lives, and we will see the mercy of extended days on earth and the mercy of an end of the suffering in Heaven, both in perspective.

Sunday, July 12, 2009

On Saturdays, I try to be a real mom, the kind of person who has
pancakes ready when her kids wake up, who sews on missing buttons and
bakes cakes and cuts hair and cheers at soccer games. I am all too
aware of the many times my kids do not get my full attention, and
appreciate their understanding, but on Saturdays I look for some
balance. The day goes by too quickly, even with the effort to be
purely domestic and ward off medical consultations and other
problems. A half dozen kids who have been friends with ours for many
years (well, mostly with Julia, who is the friendliest) help us finish
off the leftover pizza for lunch, and then I hear raucous giggling in
games of chase. This week we ended the day to slowly realize as we
watched that someone who writes movie reviews has rather different
ideas of comedy (which involve a dark and bloody plot, drugs, suicide
attempts, organized crime . . . this is funny??). At least we could
laugh at ourselves for choosing it. Oh well.

Sundays we have a big long breakfast, making cinnamon rolls and pretty
amazing coffee with fresh hot steamed milk. This week we drank in
Pamela and Pat's fellowship as a welcome addition to our usual crowd.
Church was uncharacteristically timely, where the sermon series
through Acts continues, a convicting sermon challenging us to visit
each other in our homes like Paul and Silas did. We moved our weekly
"family soccer" game (which usually includes our extended family of
team as well) up into the heat of the afternoon to be sure we could
spend that hour, which means a LOT to our kids. Then up to Bundibugyo
town to visit Dr. Jonah's grave with Pamela, and reminisce about the
days of ebola, painful memories but so good to share them with a
fellow-mourner, and to pray for his family. We timed the visit so we
could then pick up the first of our two anticipated educational
consultants for CSB. As his bus came limping in at a very severely
tilted angle we could glimpse the relief on his face as he waved
through the window. His first words getting in the car: how did you
people ever find yourselves in this place?

Yes, Bundibugyo is the end of the road, even for a middle-aged well-
educated well-traveled Ugandan who has been pretty much everywhere
(including America). We made brief stops at the two other biggest
secondary schools in the district to help him get a context for
comparing Christ School. As we approached Nyahuka, he asked again
about the selection of the location, and we told a bit of how the
campus had once been out of town, but due to rebel insurgency in the
late 90's the town expanded massively with IDP's who never went home,
and we suddenly found ourselves entrenched in a very urban landscape.
His response gave us something to ponder for the evening, something
like this: "Well, you're missionaries, so you want to be where people
are, right? Because the big mainline denominations in Uganda
historically built their churches and schools out of towns, and
thereby lost their greatest chances for impact, compared to the more
recent emergence of Islam which has centered itself squarely in the
middle of towns. Let's think of how to take advantage of this crowded
urban environment for the sake of the Gospel." Hmmm. We passed the
professor off to David and returned home at dusk for a quickly
concocted dinner combining anything left in our fridge, and then a fun
slideshow of Scott and Caleb's America adventures.

Monday is just around the corner, with all of its attendant demands
for the new week. I'm thankful for the weekend.

Friday, July 10, 2009

Pat and Pamela arrived for team meeting tonight: Pat after 3 months in Kenya and the US on a short HMA break; Pamela after 18 months in the US working with Redeemer Presbyterian Church in NYC. As we sang and prayed, I sensed the same wholeness that came with Scott and Caleb's return, the relieved comfort that something is back in place as it should be. Our team relationships extend through space and time, renewable with shared memories and hugs. We had set aside this week's team meeting to reflect on ways God was moving by prayer and partnership to invest in emerging Ugandan leadership as we work together to show the compassion of Jesus to the poorest. Very encouraging to recount the concrete ways this vision has taken on flesh, and also challenging to pray for the next steps.

The next month looks, well, FULL, as we pray and partner on ahead. We will enfold entirely new people into our lives for short periods of time, and we will be pursuing stability and sustainability and leadership transition in our ministries. Scott turned in his last Kwejuna Project quarterly report; we are no longer functioning to channel the money between EGPAF and the district. One of the nurses we sent for nutrition training is stepping up to take initiative to train other staff. Next week the first of two consultants we hired to advise us on Christ School will arrive, a Church of Uganda-affiliated professor of education (with a PhD from University of Minnesota). The process of praying for a Ugandan headmaster, and accountant, has already been set in motion. In important ways we see our role changing.

Changing, but not ending. There will still be gaps to fill. Today I was referred a 1 year old whose nonspecific viral-crud sort of illness had left him suddenly unable to walk. I found an otherwise healthy child with a floppy, immobile left leg, a clinical picture consistent with polio. So that triggered a series of phone calls and forms and lab samples that will tell us if a wild-type polio virus has infiltrated once again, a sobering reminder that the battle for health still needs vigilance and effort. At our weekly staff meeting the in-charge presented data compiled by a national survey of health facilities, and on many axes we still have miles to go, much work to do.

So tonight we pause to look soberly ahead at the road before us, and to thank God for all the saints with whom we travel this path.

Thursday, July 09, 2009

Wednesday, July 08, 2009

The pediatric ward is full of some pretty pitiful people, and this
morning I found my hard heart wishing that it wasn't. When I bent
over to examine malnourished twins and smelled the alcohol wafting up
on their mother's breath, I was annoyed with her. Then there was the
two-year-old with a tiny head and puffy body whose father admitted he
was tired of this handicapped child who cried all the time, which
explains why the kid keeps landing on our doorstep as our problem in
spite of months of supplemental food (third time he's shown up for
admission in six months). Another frighteningly malnourished child's
grandmother started complaining that she had not brought pans with her
to cook in (which everyone does) and as we talked I realized in spite
of her apparent helplessness and angling for yet more assistance,
there were three competent women in this girl's life, both maternal
and paternal grandmothers AND HER OWN MOTHER, gathered around the
bed. It seems that when her father was arrested for stealing cocoa,
her mother abandoned her to the care of one grandmother, and three
years later they are all suddenly realizing that the girls is inches
away from death. Then there is the abandoned-to-another grandmother
cerebral palsy kid whose problems already seemed pretty unsolvable,
even before she also tested positive for sickle cell disease today.
Or the little girl with severe malaria whose mother complained she had
no mosquito net, though whenl I pointed out that it was documented on
her chart that she had received two within the last year, she quickly
explained those had holes in them. In short there is hardly a patient
on the ward whose suffering is not in some way related to poor
parental choices, marriage quarrels, neglect, substance abuse,
carelessness, or just plain hard knocks in this life. And it is like
there is a neon sign on the roof of the hospital, calling all of the
most un-fixable problems, the most mired-in-distress families, to pour
on in.

But isn't that just what Jesus would want? Sure, I'd rather invite
the relatively competent, "deserving", one-concrete-medical-issue-only
types into the ward, the kind of kid that gets three doses of Quinine
and smiles and walks away healthy. The kind of kid that one can feel a
sense of accomplishment in helping. Instead Jesus tells the story of
filling his feast from the highways and the byways, pulling in those
at the margins, those that have messy lives and dysfunctional
relationships. Because in reality, that is who we all are.
Struggling parents, making bad choices, failing to love and provide,
and needing grace.

Tuesday, July 07, 2009

It has been such a relief to welcome Scott and Caleb back I did not bother to post the good news . . . but Monday evening the big red truck pulled into our yard, 20 days and 12 hours after it left, with Star yelping and Jack and Julia jumping onto the running boards and me running out to say welcome home. We had a great reunion, just the wholeness of being back together again. As we finished cooking our coming home feast, I realized I was SO HUNGRY, for the first time in three weeks, the cloud of stress of surviving alone had lifted and left me with an appetite! We laughed a lot, and opened trunks of goodies (shoes, clothes from the grandparents, chocolate chips and good coffee and nuts and pepperoni, a few dvd's and books, Christmas in July). Then we called Luke on the phone and it was almost like being a whole family again. In 10 days he'll be here, too. I'm so thankful for my family, the best people on earth.

Sunday, July 05, 2009

Here are Jack and Tim in front of the hot springs, an eerie area of sulfurous vents where boiling water steams up through cracks in the earth. We took the interns on a weekend camp-out in the Semiliki National Forest: hearing turacos and a flash of blue, watching monkeys chatter and drop through the trees, staring down baboons on the path, and every few minutes pulling viscious biting ants out of our skin. It was great. As the mosquitoes and dragon flies buzzed us around our campfire I told them it was an amazing thing to be sitting in what may be the epicenter of insect life on the planet!
Lunch on the trail, thanking God for His creative powers and unfathomable might, and taking a break from the strenuous 7 hours of hiking and ant-battling.
Julia always sticks right with the guide--nothing incongruous about a 12 year old learning to plait palm leaf fibres (used in making hats and mats) from a man in fatigues toting and automatic weapon.
This board walk covers the open wetland around one of the hot springs . . the rest of the day we were in dense tropical rainforest.

This is the view of Congo , 10 km from our starting point . . . Not seeing any crocodiles (this is the very area where the biggest one on record was found) we went down and touched the water, then hiked 10 km back through the forest.
On the way home, a peculiar clunking sound, which was not solved by a change in tires. No trip is simple here, but after extensive pondering, bolt-tightening, and a call to Scott we risked driving on home at a very slow speed (at one point I remarked that we were being passed by a butterfly). Now the Bat-mobile (aka former Bart-mobile, aka Zoolander) will wait for a mechanic to examine all the bushings and pronounce the verdict. We learned Heidi is pretty adept at popping the clutch for a roll start (the electrical system is also touchy on this vehicle, with temperamental starting and frequent random waves of the windshield wipers). Thankful to be home!

Thursday, July 02, 2009

After a long game of tag in the moonlight last night, our interns, team, and kids settled down for one of our Africa-film series videos, War Dance. This excellent documentary puts faces with the stories of three real children from Pader district in northern Uganda, and I've posted before about the power of the artistic images and the grip of the compelling story. This time through I was struck by a short scene in which an elderly teacher who has returned from the big city, Kampala, to help this small primary school prepare for the national music competition where they will compete, stands in the front of the classroom and talks to the kids. We've just heard one 14-year-old boy tell his story to the camera of being abducted by rebels and forced to kill a man with a hoe. The teacher says: Yes, you are children of war, that is part of your story . . . but it is not the end of your story.

Those words offer such hope, to the children who practice and dance and sing and prepare, who travel to Kampala and shine as they represent the Acholi people. And they are wise words for all of us scarred by evil, our own and others. Yes, we are children of war, children of the earth, and that is part of our story . . .but not the end.

A friend sent the following stanzas from East Coker (4 Quartets). As a wounded, dying healer I resonated with sharp compassion, and the inevitability of all our sicknesses growing worse, until Good Friday's cure is complete:

Wednesday, July 01, 2009

Always start well, with team prayer meeting, and the opportunity to play our little keyboard piano and sing, which I love. The last two weeks in particular, those team mates leading prayer have taken admirable risk to confess sin and ask for prayer in deep and real ways. 2 Cor 4 keeps coming up, faith, looking clearly for that which can not be seen.

Yogurt, granola, coffee, tea, making sandwiches for lunches, checking email, thinking through the day, greeting workers and making sure they are set, gathering a few supplies to restock at the hospital, getting on bikes to head off to school and work . . ..

Wednesdays are usually pretty full, with rounds on the over-crowded ward and then mid-day in the HIV clinic. Today was no exception. Sometimes the nurse coming off of night shift tells us whom she thinks is the most critically ill, so Heidi and I begin there, then proceed slowly, bed by bed. Checking labs, counting out pills, examining, touching, talking, thinking, searching for clues, trying not to miss any important danger signs, patient after patient. Sometimes the sheer effort of listening in another language fatigues. I try to think about teaching staff as we go on rounds together, too, though the extra energy for that can be hard to find. And with two interns (one pre-med and the other in med school) who are bright and questioning, I come to the end of what I know pretty quickly! I remember why parents like to justify action with "because I said so . . ". Sigh. Mid-rounds I excuse myself briefly to call the District Police Chief and complain that the rapist still has not been arrested, a moment of advocacy in the midst of science. With all the beds full a dozen or more patients are on mats on the floor, so I have to kneel or squat to examine them. One of the last kids looks pretty comatose, but responds to pressure on his hand, opens his eyes, but does not talk. I see him trying to focus on me, on his mom. So I pull out a sweet, and ask if he'd like it, and he raises his eyebrows . . and I'm reminded of Kevin coming out of his coma, and smile. This kid has severe malaria, but he'll be OK.

Then over to the clinic for AIDS patients, which is usually bustling. I see patients in a little side room, calling out "onje?" (is there another?) through the curtain as I finish with each one. As I'm tracking down a lab result, I notice one of the interns looks bored having finished weighing all the patients, and pull him in to see patients with me, more time here to discuss the complicated issues surrounding HIV-care in a resource-limited setting, something close to my heart. We tell a mother that her baby's HIV test was negative, a joy I get to repeat twice today. I notice that Barak Obama, who was named after our American president after being born in our truck on the way to the hospital, is also negative. Fun. I review the 5-years-of-growth-chart data on Mumbere, who has the ID number 4 (out of a thousand or so), one of our first HIV patients. This is where he came starving and malnourished, this is where he got TB, this is where his mom died, this is where he began anti-retrovirals, this is where his grandmother took over his care. Later I notice a baby whose mother coughs, a lot, and I send her for TB testing, no use to just treat the baby when his greatest risk is probably his mom's untreated infection. In and out of the exam room, connecting some patients with peer counselors, making sure that CD4 counts are being collected, that medicines are being dispensed.

Back to the ward, malnourished twins have arrived, a rather complicated (and in duplicate) ending to a five-hour morning . . then notice that three of our best nurses are struggling to get an IV in a very anemic child, who is going into shock. While they keep trying, I walk the medical student (who has EMT experience) through an intra-osseous line. He gets it in, but we are not getting good flow, and by that time the nurses get an intra-venous line.

Brief stop at CSB to discuss some team issues, then back home for an hour, firing off a few emails and counting out funds to send 30 blood samples for CD4 testing (has to be done in Fort Portal), with the bonus of returning with blood for transfusions from the blood bank. Back to CSB for chapel, very optional, but an opportunity to greet a few staff and students, touch base with Jack and Julia, pray while the chaplain preaches, for heart transformation and spiritual growth and cultural change and peace at the school.

Then cooking dinner, Jack and Julia stay for football (soccer) pick-up games with kids at school, and I'm alone for the first time since 6 a.m. Liz from the WHM office has sent me a fantastic sermon series, so instead of the radio, I put one on as I cook, knowing I need my frazzled focus to be re-directed to Jesus. The story is of Mary Magdalene, of looking beyond the voices in our lives which tell us who we are, to the unseen reality of what God says is true. Again, looking clearly for that which can not be seen. I've seen a lot of grief and anxiety and conflict and instability over the course of the day, and I realize how strongly I want to blame my stress on the situation, want to have the problems fixed my way, instead of waiting on God.

Wednesday nights are family night. Right now that's just three of us, but we set out our best plates and glasses and light our candles and eat our spaghetti with freshly made sauce. I'm so thankful for this protected evening, setting ministry and other relationships aside, to listen to my kids tell about their friends, about what a teacher said or how a soccer play went. Their lives are not always easy. Today Jack was blatantly fouled from behind while dribbling the soccer ball, then had lots of kids jeer at him as he rode his bike alone up the road, and came home to chores and the news that he has an unexpected chemistry test at 8 in the morning. That's a lot for an 11 year old to take. So we talk, and call Luke, and listen to music, wash dishes, read out loud, until Wednesday fades into sleep.

Our Mission

who we are

paradox:
1. something that combines contradictory features or qualities.
Life in Africa is full of contradictions - the beauty and pain; the abundance and the poverty; the joy and the sorrow.
Our lives, too...dying that we might live; strong in our weakness; sinners yet saints.
2. a "pair of docs"